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Sano T, Kato M, Sassa N, Sadachi R, Hirakawa A, Kamihira O, Hirabayashi T, Nishikimi T, Katsuno S, Kimura T, Hattori R, Gotoh M, Tsuzuki T. pT3 subclassification of renal pelvic cancer considering the tumor location improves the patients' prognostic accuracy. Virchows Arch 2021; 478:1089-1097. [PMID: 33420835 DOI: 10.1007/s00428-020-02973-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/09/2020] [Accepted: 11/15/2020] [Indexed: 12/30/2022]
Abstract
Whether pT3 urothelial carcinoma of the renal pelvis (UCRP) and urothelial carcinoma of the ureter (UCU) have the same prognosis is controversial, this study compared the prognosis of pT3 UCRP with that of pT3 UCU. We retrospectively evaluated 954 patients who underwent nephroureterectomy at our institutions between January 1983 and December 2017. All surgical specimens were reviewed by a single genitourinary pathologist. Cases of pT3 UCRP were subclassified as pT3a (urothelial carcinomas extending only to the renal medulla) and pT3b (urothelial carcinomas extending into the renal cortex and/or peripelvic adipose tissue). Fine and Gray's model was used to predict recurrence-free survival (RFS) and cancer-specific survival (CSS). A total of 493 (51.7%) had UCRP and 461 (48.3%) had UCU. Within this group, 202 patients had pT3 UCRP and 146 had pT3 UCU. The pT3 subclassification of UCRP resulted in 79 cases of pT3a and 120 of pT3b. The difference in 5-year CSS among the pT3a UCRP, pT2 UCRP, and pT2 UCU subgroups was not statistically significant (pT3a UCRP vs pT2 UCRP, HR = 0.69, p = 0.56; pT3a UCRP vs pT2 UCU, HR = 0.66, p = 0.31) However, RFS and CSS were significantly higher in the pT3a UCRP group than in the pT3b group (pT3a vs pT3b, HR = 2.59, p = 0.0038 and pT3a vs pT3b, HR = 3.10, p = 0.001). The results suggest that our proposed pT3 subclassification better predicts the prognosis of UCRP patients than does the pT3 of the current AJCC/UICC classification.
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Affiliation(s)
- Tomoyasu Sano
- Department of Urology, Nagoya University Graduate School of Medicine, Tsuruma-Cho, Showa-Ku, Nagoya, 466-0065, Japan
| | - Masashi Kato
- Department of Urology, Nagoya University Graduate School of Medicine, Tsuruma-Cho, Showa-Ku, Nagoya, 466-0065, Japan
| | - Naoto Sassa
- Department of Urology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Japan
| | - Ryo Sadachi
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-8654, Tokyo, Japan
| | - Akihiro Hirakawa
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-8654, Tokyo, Japan
| | - Osamu Kamihira
- Department of Urology, Komaki City Hospital, 1-20 Jobushi, Komaki, 485-8520, Japan
| | - Tsuyoki Hirabayashi
- Department of Urology, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Toshinori Nishikimi
- Department of Urology, Japanese Red Cross Nagoya Daini Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Satoshi Katsuno
- Department of Urology, Okazaki City Hospital, 3-1, Goshoai-aza, Koryuji-cho, Showa-ku, Okazaki, 444-8553, Japan
| | - Toru Kimura
- Department of Urology, Japan Community Healthcare Organization Chukyo Hospital, 1-1-10, Sanjo, Minami-ku, Nagoya, 457-8510, Japan
| | - Ryohei Hattori
- Department of Urology, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Douge-Cho, Nakamura-Ku, Nagoya, 453-8511, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Tsuruma-Cho, Showa-Ku, Nagoya, 466-0065, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Japan.
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Kim HS, Jeong CW, Kwak C, Kim HH, Ku JH. Association between demographic factors and prognosis in urothelial carcinoma of the upper urinary tract: a systematic review and meta-analysis. Oncotarget 2018; 8:7464-7476. [PMID: 27448978 PMCID: PMC5352335 DOI: 10.18632/oncotarget.10708] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/06/2016] [Indexed: 01/23/2023] Open
Abstract
We aimed to assess the prognostic significance of demographic factors, including age, sex, performance status, smoking status, obesity, and race in upper urinary tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy through a systematic review and meta-analysis. We conducted PubMed search for all articles published until December 2014 according to Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Survival outcomes of interest were intravesical recurrence (IVR) free survival, progression free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Seventy-nine studies, including numbers of subjects ranging from 24 to 9899, met the inclusion criteria. Advanced age was significantly associated with worse PFS [hazard ratio (HR) 1.01] and OS (HR 1.05). The significant predictors of CSS were age (HR 1.02) and performance status (HR 1.35). Female gender (HR 0.81) and smoking (HR 1.38) were the significant predictors only for IVR free survival. No significant associations with survival outcomes were observed in obesity and race. Our study reveals that age is one of the most important demographic predictor of survival in UTUC. Also, male gender, poor performance status, and smoking are also significantly related to worse survival outcomes. However, large well-designed prospective studies are required to investigate the precise prognostic significance of demographics.
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Affiliation(s)
- Hyung Suk Kim
- Department of Urology, Dongguk University Ilsan Medical Center, Goyang, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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Qin C, Liang EL, Du ZY, Qiu XY, Tang G, Chen FR, Zhang B, Tian DW, Hu HL, Wu CL. Prognostic significance of urothelial carcinoma with divergent differentiation in upper urinary tract after radical nephroureterectomy without metastatic diseases: A retrospective cohort study. Medicine (Baltimore) 2017; 96:e6945. [PMID: 28538387 PMCID: PMC5457867 DOI: 10.1097/md.0000000000006945] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To evaluate the impact of urothelial carcinoma with divergent differentiation (UCDD) on the prognosis of patients for primary upper urinary tract urothelial carcinoma (UTUC) with pN0/x status treated with radical nephroureterectomy (RNU) and to evaluate the prognostic value of UCDD in different tumor locations (renal pelvis and ureter).Data from a total of 346 patients with UTUC who received RNU between January 2012 and March 2016 in the institution were retrospectively analyzed. Clinicopathological features and prognostic factors age, sex, complaint, height, weight, blood pressure, tumor grade, stage, smoking status, history of adjuvant chemotherapy, tumor location, history of bladder cancer, tumor necrosis, degree of hydronephrosis, tumor size, tumor focality, and preoperative anemia were compared between patients with pure UTUC and patients with UCDD. The endpoints were cancer-specific survival (CSS), overall survival (OS), and intraluminal recurrence-free survival (IRFS).Overall, divergent differentiation was present in 50 patients (14.5%). UCDD was related to different tumor location (P = .01), smoking (P = .04), higher body mass index (P = .02), and advanced tumor grade (P = .01). By Kaplan-Meier analysis, UCDD was found to be significantly correlated with worse IRFS, CSS, and OS (all P < .01). Multivariate analysis demonstrated that UCDD was an independent predictor of IRFS (P < .01), CSS (P = .01), and OS (P = .01). However, 40 patients died for various reasons and the 5-year OS rates were 91.9% in UCDD- group and 68.0% in UCDD+ group, respectively. In patients with ureteral tumors, UCDD was the significant predictor for IRFS, CSS, and OS. However, the prognostic value of UCDD was not observed in pyelocaliceal tumors.The presence of divergent differentiation is associated with inferior survival. UCDD may identify patients at high risks for poor prognosis especially in patients with ureteral tumors. As a result, more attention and follow-up should be given to patients with ureteric urothelial carcinoma.
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Affiliation(s)
- Chuan Qin
- Department of Urology
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University
| | - En-Li Liang
- Department of Urology
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University
| | - Zhi-Yong Du
- Department of Urology
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University
| | - Xiao-Yu Qiu
- College of Management and Economics, Tianjin University, Tianjin, China
| | - Gang Tang
- Department of Urology
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University
| | - Fei-Ran Chen
- Department of Urology
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University
| | - Bo Zhang
- Department of Urology
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University
| | - Da-Wei Tian
- Department of Urology
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University
| | - Hai-Long Hu
- Department of Urology
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University
| | - Chang-Li Wu
- Department of Urology
- Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University
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Lee HY, Li CC, Huang CN, Ke HL, Li WM, Liang PI, Yang SF, Tu HP, Wu WJ, Yeh HC. Prognostic significance of lymphovascular invasion in upper urinary tract urothelial carcinoma is influenced by tumor location. Ann Surg Oncol 2014; 22:1392-400. [PMID: 25239005 DOI: 10.1245/s10434-014-4103-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND To examine the prognostic value of lymphovascular invasion (LVI) in different tumor locations (i.e., renal pelvis and ureter) of upper urinary tract urothelial carcinoma (UTUC). METHODS Data from a total of 250 patients with nonmetastatic UTUC who received radical nephroureterectomy between 2004 and 2010 at our institution were analyzed retrospectively. The significance of LVI and other relevant factors on cancer-specific survival (CSS), metastasis-free survival (MFS), and intraluminal recurrence-free survival (IRFS) were evaluated. RESULTS Lymphovascular invasion was present in 60 patients (24 %) and was related to advanced pathological T stage (P < 0.001), higher tumor grade (P < 0.001), lymph node metastasis (P = 0.005), and pyelocaliceal tumor location (P = 0.002). By Kaplan-Meier analysis, LVI was found to be significantly correlated with worse CSS and MFS but not with IRFS. Multivariate analysis showed that high pathological T stage and regional lymph node involvement were significant prognostic factors for CSS and MFS, and LVI was an independent predictor for MFS (hazard ratio 1.71, 95 % confidence interval 1.00-2.93, P = 0.049). In patients with ureteral tumors, LVI represented the only significant prognosticator for both CSS and MFS in multivariate analysis. The prognostic value of LVI was not observed in pyelocaliceal tumors. CONCLUSIONS The implication of LVI on prognosis, particularly in ureteral tumors but not in pyelocaliceal tumors, may imply diverse disease characteristics between different tumor locations among UTUC. LVI is essential to identify patients at high risk for metastasis/mortality and can facilitate treatment planning and surveillance strategies, especially in patients with ureteral tumors.
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Affiliation(s)
- Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Ku JH, Byun SS, Jeong H, Kwak C, Kim HH, Lee SE. Lymphovascular invasion as a prognostic factor in the upper urinary tract urothelial carcinoma: A systematic review and meta-analysis. Eur J Cancer 2013; 49:2665-80. [PMID: 23721778 DOI: 10.1016/j.ejca.2013.04.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 04/06/2013] [Accepted: 04/22/2013] [Indexed: 12/30/2022]
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Sassa N, Tsuzuki T, Fukatsu A, Majima T, Kimura T, Nishikimi T, Yoshino Y, Hattori R, Gotoh M. Is pT3 urothelial carcinoma of the renal pelvis a homogeneous disease entity? Proposal for a new subcategory of the pT3 classification. Histopathology 2012; 61:620-8. [DOI: 10.1111/j.1365-2559.2012.04183.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Remzi M, Shariat S, Huebner W, Fajkovic H, Seitz C. Upper urinary tract urothelial carcinoma: what have we learned in the last 4 years? Ther Adv Urol 2011; 3:69-80. [PMID: 21869907 DOI: 10.1177/1756287211403349] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
In the last 4 years many studies have been published on the topic of upper urinary tract urothelial carcinoma (UTUC). This is a recent review of the available literature of the last 3 years. A systematic Medline/PubMed search on UTUC including limits for clinical trials and randomized, controlled trials was performed for English-language articles using the keywords 'upper urinary tract carcinoma', 'nephroureterectomy', 'laparoscopic', 'ureteroscopy', 'percutaneous', 'renal pelvis', 'ureter' and their combinations from January 2008 to December 2010. Additional selected reports from 2007 were included. Case reports and non-English literature were excluded. Publications were mostly retrospective, including some large, multicentre studies from the Upper Tract Urothelial Carcinoma Collaboration (UTUCC). The authors of this article are members of the UTUCC. Altogether, 92 original articles dealing with UTUC were identified and summarized. The vast majority of the available literature has a low level of evidence (level IV), although many multicentre studies tried to overcome the problem of low numbers by pooling data. It was concluded that in the last 3 years our knowledge regarding UTUC has increased dramatically, although new study concepts allowing us to increase the level of evidence are needed.
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Affiliation(s)
- Mesut Remzi
- Landeskrankenhaus Weinviertel-Korneuburg, Wiener-Ring 3-5, 2100 Korneuburg, Austria
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[Urothelial carcinoma of the upper urinary tract: clinical and pathological criteria and their predictive implications after radical nephroureterectomy]. Wien Med Wochenschr 2011; 161:366-70. [PMID: 21953425 DOI: 10.1007/s10354-011-0015-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 07/14/2011] [Indexed: 10/17/2022]
Abstract
Recent multicentric studies contributed significantly to the understanding of clinical and pathological criteria and their implications as prognosticators of the upper urinary tract urothelial carcinoma. They demonstrated a large variety of prognosticators influencing the course of this rare disease. The influence of gender and age and the presence of symptoms and renal obstruction in addition to pathologic criteria such as staging, tumor architecture, lymphnode invasion, localization and the presence of CIS or tumor necrosis on prognosis and disease recurrence after radical nephroureterectomy were investigated. Additional multicentric, ideally prospective studies are warranted to validate current findings.
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Abstract
Upper urinary tract urothelial carcinoma (UTUC) is a rare disease, which means there are little evidence-based data available to guide clinical decision-making. Although diagnosis and treatment of UTUC have improved significantly over the last 5 years, accurate risk stratification remains a challenge owing to the difficulty of clinical staging. A number of potential prognostic factors have been identified, encompassing clinical characteristics, pathological factors and molecular markers. Tumor stage and lymph node status are the most important predictors of survival in patients with UTUC. Preoperative evaluation for hydronephrosis can identify patients at risk of non-organ-confined disease. In the subgroup of patients with stage ≥pT2 disease, a longer interval between diagnosis and radical nephroureterectomy is associated with a higher risk of disease recurrence and cancer-specific mortality. Extensive tumor necrosis, sessile tumor architecture and lymphovascular invasion are independent predictors of clinical outcomes for patients with UTUC treated with radical nephroureterectomy. The incorporation of such prognosticators into clinical prediction models might help to guide decision-making with regard to timing of surveillance, type of treatment, performance of lymphadenectomy, and consideration of neoadjuvant or adjuvant systemic therapies.
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Ferriero M, Simone G, Gallucci M. Re: Lymphovascular invasion predicts poor outcome of urothelial carcinoma of the renal pelvis after nephroureterectomy. BJU Int 2009; 103:1143. [PMID: 19338572 DOI: 10.1111/j.1464-410x.2009.08553_3.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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